Education and income level and their relationship with breastfeeding duration: 8949 mother-infant pairs in the Born In Guangzhou Cohort Study (BIGCS)

摘要

Background: Guangzhou is one of the most rapidly developing urban centres in the world. Economic development and social progress have undoubtedly influenced health behaviours, like breastfeeding, across the socioeconomic gradient for the region. Recently provincial regulations on maternity-leave have changed, extending the former 98 day provision to 178 days. It is likely that the new policy will improve regional breastfeeding rates; however, the currently available data on breastfeeding populations in Guangzhou is poor. More robust studies are needed to evaluate in future how continued economic progress effect breastfeeding rates across different socioeconomic groups, and if the new policy changes have had the beneficial impact expected. Objective: This study aims to assess sociodemographic disparities, measured by education and average monthly income level, on the risk of breastfeeding cessation before 1-year post-partum in a large prospective cohort study in Guangzhou. Methods: Data on the education and income level of mothers and fathers in the Born In Guangzhou Cohort Study were extracted for infants born between February 2012-September 2015. Multivariable Cox regression analysis was used to assess the association between the education and income level of both the mother and the father, and the risk of breastfeeding cessation before 1-year. Results: 8949 mother-infant pairs were analysed. The median breastfeeding duration was 7.0 months (interquartile range: 6.0). At 6-months postpartum 73.0% (95%CI 72.1-73.9) of mothers were still breastfeeding, and by 12-months 19.4% (95%CI 18.6-20.3) remained. After multivariable adjustment, there was a significant inverse linear association between education and the risk of early breastfeeding cessation. With each additional level of maternal education above high school, the risk of early breastfeeding cessation dropped by 10% (HR: 0.90, 95%CI 0.86-0.93). A similar trend was observed for the association with the father's education level as well. There was no association between the income level of either parent and the risk of breastfeeding cessation before 1 year. Conclusions: The socioeconomic breastfeeding patterns observed here more closely resemble patterns observed in developed populations than other regions in China. Thus, these findings may indicate that as the socioeconomic distribution in Guangzhou moves towards what is seen in other more developed societies, so do breastfeeding patterns. Given the long-term health benefits of breastfeeding and the consequences of not, both for the mother and infant, public health intervention is needed to prevent breastfeeding rates in Guangzhou from falling to levels seen previously in high-income countries.